Community Health Center to separate from county

After operating for more than a decade under the Flathead County umbrella, the Flathead Community Health Center is poised to separate from the county on June 1 and establish itself as a completely independent entity.

Discussions surrounding the center’s split from the county emerged last summer during public meetings with the Flathead City-County Health Department Board of Health and Flathead County commissioners. However, according to Health Center Executive Director Mary Sterhan, the entities have been slowly working toward the separation for more than a year now, but the process was temporarily sidelined by the COVID-19 pandemic.

Several years ago the commissioners approached facility leaders saying they thought it might be in the best interest of the Health Center and its patients if it operated separately from the county. Sterhan said the elected officials specifically expressed interest in “getting out of the business of providing health care,” a trend that has occurred elsewhere in the state as community health centers in areas such as Cascade and Lewis and Clark counties have pulled out from under government oversight.

“Local governments used to be deeply involved in a lot of different realms of health care, like in nursing homes and hospitals, but over the years they have gradually moved away from that,” Sterhan said. “A community clinic isn’t meant to operate in a government structure and we aren’t really a government entity. Our intent is to serve the underserved and we can do that best if we are independent.”

Commissioner Pam Holmquist said in a recent interview that the Health Center, which serves roughly 8,000 Flathead Valley residents, functions differently than most other county departments and “has a lot of moving parts.” Sterhan, who stepped into her role almost two years ago, agreed with that sentiment.

SHERHAN EXPLAINED that operations at the Health Center’s clinics must remain flexible, particularly during times like the COVID-19 pandemic. But altering day-to-day operations as a county department can be challenging, considering the center must gain commissioner approval before making various financial or staffing changes — a process that often proves time-consuming.

For example, if the Health Center needed to use its funds to purchase much-needed equipment, change someone’s title, either temporarily or permanently, or hire additional staff members, commissioners need to greenlight those decisions. And in order to do that, the center, which offers primary medical care, dental and behavioral health services at its Kalispell and Hungry Horse clinics, must first get the item onto their agenda. That can take weeks, or even months, depending on needs in other county departments.

“The Health Center has more immediate needs than a lot of other county departments and the pandemic is a perfect example of that. When the virus hit here we had to switch some people’s roles and make changes to our services and we had to do it quickly,” Sterhan said. “Even though we operate fairly independently, they [the commissioners] are a level of influence that exists, and explaining what it takes to run a clinic or even getting on their calendar can be a challenge. A vibrant health health center really thrives as an independent entity.”

Sterhan said timely decisions are perhaps most important when it comes to staffing. Each employee fulfills their specific medical role, so if one person suddenly quits or they must go on temporary leave, their duties can’t be fulfilled by another employee. Appointments then need to be canceled or rescheduled, which Sterhan said leads to a decrease in both the quantity and quality of care provided at the center.

“Take the roads department for instance. If a few employees don’t show up for work that day, the team can kind of reassess and either do what they can on that road or go and work on another project for that day. They can still get things done,” Sterhan said. “That’s not really the case with a health center or a hospital or any other medical facility. If one of our doctors is out, a dentist can’t necessarily fill in.”

AS THINGS currently stand, the Community Health Center operates as a division of the Flathead City-County Health Department.

Public Health Officer Joe Russell said the relationship between the two health facilities is one that dates back decades to when he was approached in the late 1990s by federal government officials. They insisted Flathead County’s population and health statistics warranted a federally qualified community health center.

But in order to receive grant funding through the Human Resources and Services Administration (HRSA), the center had to already be established and it had to prove that it provided services to medically underserved communities. And the opportunity to bring the center to fruition wouldn’t come until about several years later, when Montana’s Legislature adopted a program that focused on funding community health facilities.

Flathead County became the first county in the state to participate in the program.

The funds allowed the center to be established as a division of the health department, and in the meantime, the county formed a nonprofit corporation for it to operate under called the Flathead Community Health Center, a moniker it has maintained for more than a decade.

And according to Sterhan, the Health Center was approved for funding under HRSA shortly after opening its doors, yet the entity remained nested within the health department. That’s why even today, if one were to search HRSA grants, they’ll discover the grantee of the Health Center’s funding is Flathead County.

HOWEVER, THAT will change when the next HRSA grant cycle begins on June 1.

At that time, Sterhan said the grantee will switch to the Health Center itself, which currently operates on an annual budget of $6 million, a good portion of which comes from HRSA grants. It will continue to function as a nonprofit corporation and its existing co-applicant board, made up of patients who are served by the center, and others, will remain in place.

“Not a lot will change overall,” Sterhan said. “We will still be funded the same, we will have all of our services in place and the board is coming. We just won’t be a part of the county.”

The clinic in Kalispell will also continue to be housed in its county-owned building, which it has leased from the health department over the years.

Holmquist said she and the other commissioners, who are in charge of overseeing county property, are finalizing a new commercial lease that hopefully will allow the clinic to stay in its location at First Avenue West in Kalispell for several years.

They have not settled on the price of the lease, but Holmquist said she anticipates it will be higher than what the Health Center is currently paying because the facility has expanded its footprint throughout the years and it has added more services.

The commissioners are still in the process of evaluating the square footage of the space, which will serve as the base for the price of the lease. Once the county attorney completes the commercial contract, the Health Center will have an opportunity to make a counter offer.

Reporter Kianna Gardner may be reached at 758-4407 or kgardner@dailyinterlake.com